Abstract

Background: The neoplasms of bone account for only 0.2%–0.5% of the overall human tumour biology. Most bone tumours arise de-novo from genetic mutations; but numerous risk factors such as chemotherapy, irradiation, foreign bodies, bone infarcts and pre-existing bone lesions have been implicated. Bone tumours have heterogeneous population of cells and morphology. For accurate diagnosis of tumours and tumour like lesions of bone, there is a need of tissue diagnosis & staging and radiological diagnosis to delineate the plane of tumour involvement and its appropriate management.
Objectives: To study the spectrum of clinico-radiological & histopathological features and management of tumour and tumour like lesions of bone and to establish the statistical significance by testing the agreement between clinicoradiological and histopathological diagnosis by Cohen’s kappa value.
Materials and Methods: A total of 76 cases (14 clinical entities) were taken in our study. All cases underwent thorough clinical, hematological and radiological investigations to arrive at an empirical diagnosis of the lesions. Then all patients were subjected for histopathological tissue sampling (FNAB (Fine Needle Aspiration Biopsy) or incisional biopsy) for accurate diagnosis which guide the orthopaedic surgeon to plan the appropriate line of management. All the cases were under surveillance for diagnosing the development of metastasis.
Results: The histopathological correlation of 95.37% with 97.25% sensitivity, 95.41% specificity, 97.01% positive predictive value and 95.41% negative predictive value in diagnosing musculoskeletal tumours. The strength of agreement between clinico-radiological and histopathological diagnosis by Cohen’s kappa value was very good (κ=0.817).
Conclusion: The management of tumours and tumour like lesions of bone pose a greater challenge for an orthopaedic surgeon in instituting treatment modalities. The successful diagnosis of bone tumour and its management depends on collaboration between the orthopaedic surgeon and the pathologist who determine the need for secondary biopsy in diagnosing bone and soft tissue tumourse.

Keywords: Bone Tumours; Cohen’s Kappa; Histopathology; Fine Needle Aspiration Biopsy (FNAB); Incisional Biopsy